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To determine parental experiences and preferences regarding the conduct of pediatric research in an emergency department (ED) setting.

Methods

We conducted a cross-sectional study of parents of children ages 0 – 14 years who visited the ED of a tertiary care children’s hospital. Parents completed a Web-based survey designed to assess perceptions regarding: 1) background/training of research personnel, 2) location and timing of research discussions, and 3) factors influencing their consent/refusal decision.

Results

Parents totalling 339 were approached, and 227 (67%) surveys were completed. Overall, 87% (197/227; 95% confidence interval [CI] 83, 92) reported they would be comfortable being approached by a university student to discuss research. This proportion did not change when stratified by the child’s gender, illness severity, or season of visit. Whereas only 37% (84/227; 95% CI 31, 43) of respondents would be comfortable being approached in the waiting room, 68% (154/227; 95% CI 62, 75) would be comfortable if approached in a separate area of the main waiting room. The majority reported comfort with follow-up via email (83%; 188/227; 95% CI 78, 88) or telephone (80%; 182/227; 95% CI 75, 85); only 51% (116/227; 95% CI 44, 57) would be comfortable with a scheduled follow-up visit in the hospital. Participants identified potential complications or side effects as the most common reason for declining consent (69%; 157/227; 95% CI 63, 75).

Conclusions

The majority of parents are comfortable being approached by trained university students, preferably in a separate area of an ED waiting room, and email and telephone follow-ups are preferred over a scheduled re-visit.

Australian-born participants (n 5879) aged 40 to 69 years who were not current smokers and who were free from common chronic diseases at recruitment. At baseline and at wave 2, weight and waist circumference were measured; while demographic and lifestyle variables were obtained at baseline via structured interviews.

Results

Participants who reported any recreational physical activity at baseline had lower weight and smaller waist circumference at wave 2 than those who did not, particularly for younger participants and for vigorous physical activity. Walking for leisure was not associated, and greater physical activity at work was associated, with greater adiposity measures at wave 2. A diet low in carbohydrates and fibre, but high in fat and protein, predicted greater weight and waist circumference at wave 2. Participants were less likely to have elevated weight or waist circumference at wave 2 if they consumed low to moderate amounts of alcohol.

Conclusions

Our findings indicate that promoting vigorous physical activity, encouraging a diet high in carbohydrate and fibre but low in fat and protein, and limiting alcohol intake could be promising approaches for preventing obesity in middle-aged adults. Similar interventions should successfully address the management of both weight and waist circumference, as they were predicted by similar factors.

A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.

Alexander Litvinenko died on November 23, 2006, from acute radiation sickness syndrome caused by ingestion of polonium-210 (210Po).

Objective.

The objective was to assess the prevalence of and risk factors for internal contamination with 210Po in healthcare workers (HCWs) caring for the contaminated patient.

Setting.

Hospital.

Participants.

HCWs who had direct contact with the patient.

Methods.

We interviewed 43 HCWs and enquired about their activities and use of personal protective equipment (PPE). Internal contamination was denned as urinary 210Po excretion above 20 mBq within 24 hours. We obtained risk ratios (RRs) for internal contamination using Poisson regression.

Results.

Thirty-seven HCWs (86%) responded, and 8 (22%) showed evidence of internal contamination, all at very low levels that were unlikely to cause adverse health outcomes. Daily care of the patient (washing and toileting the patient) was the main risk factor (RR, 3.6 [95% confidence interval (CI), 1.1-11.6]). In contrast, planned invasive procedures were not associated with a higher risk. There was some evidence of a higher risk associated with handling blood samples (RR, 3.5 [95% CI, 0.8-15.6]) and changing urine bags and/or collecting urine samples (RR, 2.7 [95% CI, 0.8-9.5]). There was also some evidence that those who reported not always using standard PPE were at higher risk than were others (RR, 2.5 [95% CI, 0.8-8.1]).

Conclusions.

The sensitive quantitative measurement enabled us to identify factors associated with contamination, which by analogy to other conditions with similar transmission mechanisms may help improve protection and preparedness in staff dealing with an ill patient who experiences an unknown illness.

The interface between ultrathin sputtered lead zirconate titanate (PZT) films and a conductive electrode (indium tin oxide-ITO) is investigated. Structural and compositional changes at the PZT-ITO interface have been examined by surface analysis and depth profiling techniques of glancing angle X-ray diffraction, Rutherford backscattering (RBS), SIMS, Auger electron spectroscopy (AES), and elastic recoil detection analysis (ERDA). Studies indicate significant interdiffusion of lead into the underlying ITO layer and glass substrate with a large amount of residual stress at the interface. Influence of such compositional deviations at the interface is correlated to an observed thickness dependence in the dielectric properties of PZT films.

Coatings of biologically active molecules on synthetic ”bulk“materials are of much interest for biomedical applications since they can in principle elicit specific, predictable. controlled responses of the host environment to an implanted device. However, issues such as shelf life. storage conditions, biological safety, and enzymatic attack in the biological environment must be considered; synthetic proteins may offer advantages. In this study we investigated the covalent immobilization onto polymeric materials of synthetic proteins which possess some properties that mimic those of the natural protein collagen, particularly the ability to form triple helical structures, and thus may provide similar bio-responses while avoiding enzymatic degradation. In order to perform immobilization of these collagen-like molecules (CLMs) under mild reaction conditions, the bulk materials are first equipped with suitable surface groups using rf plasma methods. Plasma polymer interlayers offer advantages as versatile reactive platforms for the immobilization of proteins and other biologically active molecules. Application of a thin plasma polymer coating from an aldehyde monomer is particularly suitable as it enables direct immobilization of CLMs by reaction with their terminal amine groups, using reductive amination chemistry. An alternative route is via plasma polymer layers that contain carboxylic acid groups and using carbodiimnide chemistry. A third route makes use of alkylamme plasma polymer interlayers, which are less process sensitive than aldehyde and acid plasma coatings. A layer of poly-carboxylic acid compounds such as carboxylic acid terminated PAMAM-starburst dendrimers or carboxymethylated dextran is then attached by carbodiimide chemistry onto the amine plasma layer. Amine-terminated CLMs can then be immobilized onto the poly-carboxylic acid layer. Surface analytical methods have been used to characterize the immobilization steps and to assess the surface coverage. Initial cell attachment and growth assays indicate that the biological performance of the CLMs depends on their amino acid sequence.

By
Mike Slade, Reader in Health Services Research at the Institute of Psychiatry, King's College London, UK,
Sonia Johnson, Professor of Social and Community Psychiatry, Department of Mental Health Sciences, University College London, and Camden and Islington NHS Foundation Trust, London, UK,
Michael Phelan, Consultant Psychiatrist, West London Mental Health NHS Trust, London, UK,
Graham Thornicroft, Professor of Community Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK

A needs-led approach to the provision of mental healthcare has been one of the most consistent themes to emerge within evolving community mental healthcare services. In England this was first expressed in the provisions of the National Health Service and Community Care Act 1990. The central tenet of a needs-led approach is that assessment of the needs of patients should be on the basis of their individual circumstances, problems and personal goals. Assessment should not be undertaken in terms of or on the basis of existing services, that is, assessment should not be service based. This means that assessment of need is a separate process from decisions about what care or treatment to provide.

Needs-led assessment should, for example, look at whether people have access to enough activities which are meaningful (to them) each day, rather than whether they need to attend a day centre. If the assessment indicates that there is a problem with daytime activities, one service response might be a place at a day centre. Another, however, might be support in undertaking voluntary work. Needs-led assessments have two advantages over service-based assessments: first, they point to the most appropriate form of service response (in terms of treatment or care) for the individual's difficulties; and second, they have the potential to indicate needs for which there is currently no service provision, which a service-based assessment by definition would not identify.

What is a need?

People with severe mental illness usually have a wide range of clinical and social needs. A variety of approaches to defining need have been proposed. The American psychologist Maslow (1954) established a hierarchy of need when attempting to formulate a theory of human motivation. In Maslow's model, fundamental physiological needs (such as the need for food) underpin the higher needs of safety, love, self-esteem and self-actualisation. He proposed that people are motivated by the requirement to meet these needs, and that higher needs could be met only after the lower and more fundamental needs were met. This approach can be illustrated by the example of a homeless man, who is not concerned about his lack of friends while he is cold and hungry. However, once these physiological needs have been met he may express more interest in having the company of other people.

To determine the incidence of transmission of MDR Acinetobacter baumannii and Pseudomonas aeruginosa from patients to healthcare workers (HCWs) during routine patient care.

Design.

Prospective cohort study.

Setting.

Medical and surgical intensive care units.

Methods.

We observed HCWs who entered the rooms of patients colonized with MDR A. baumannii or colonized with both MDR A. baumannii and MDR P. aeruginosa. We examined their hands before room entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal of gloves and/or gowns and before hand hygiene.

Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDR A. baumannii. MDR A. baumannii appears to be more easily transmitted than MDR P. aeruginosa and perhaps more easily transmitted than previously studied methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. This ease of transmission may help explain the emergence of MDR A. baumannii.

Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years.

Aims

Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations.

Method

National cross-sectional survey of alternatives to standard acute in-patient care.

Results

We found 131 services intended as alternatives. Most were hospital-based and situated in deprived areas, and about half were established after 2000. Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives. Most people using the alternatives had a previous history of admission, but only a few community-based services accepted compulsory admissions.

Conclusions

Alternatives to standard acute psychiatric wards represent an important, but previously undocumented and unevaluated, sector of the mental health economy. Further evidence is needed to assess whether they can improve the quality of acute in-patient care.